Is essential newborn care provided by institutions and after home births? Analysis of prospective data from community trials in rural South Asia

Abstract Background Essential newborn care is a wide-ranging strategy intended to improve the health of newborns by implementing appropriate interventions. Approximately in 2018, an estimated 2.5 million children died in their first month of life, which is approximately 7000, newborns every day, with about a third of all neonatal deaths occurring within the first day after birth. Even though the most cause of death is preventable the burden of neonatal death is a still high in developing countries including Ethiopia. Therefore this study is aimed to assess the level of essential newborn care practice among mothers who gave birth within the past six months in Gurage Zone, Southwest Ethiopia. Methods A community-based cross-sectional study was conducted among mothers who gave birth within the past six months in Gurage Zone, Southwest Ethiopia. For the quantitative part, 624 study participants were involved by using a multi-stage sampling method. A systematic random sampling technique was to reach the study subjects. Data entry was carried out by Epi data version 4.0.0 and analysis was done by SPSS window version 24. Binary and multivariate logistic regressions were used to identify associated factors. For the qualitative part, three focus group discussions (FGD) with purposively selected 30 mothers were involved. The data were analyzed deductively by using the thematic framework analysis approach by using Open code version 4.02. Result Overall good essential newborn care practice was found to be 41.0% [95%CI, 36.6–44.7]. Being urban residence [AOR 1.70, 95%CI: 1.03–2.79], attending antenatal care visit [AOR = 3.53, 95%CI: 2.14–5.83], attending pregnant mothers meeting [AOR = 1.86, 95%CI: 1.21–2.86], had immediate postnatal care [AOR = 3.92, 95% CI: 2.65–5.78], and having good knowledge about ENC [AOR = 2.13, 95% CI: 1.47–3.10] were significantly associated with good essential newborn care practice. Conclusion This study indicated that the magnitude of essential newborn care practice was low. Thus, a primary health care provider should regularly provide ENC for newborns and take opportunities to counsel the mothers about ENC during pregnant mothers meeting and MCH services sessions.

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Early essential newborn care is associated with improved newborn outcomes following caesarean section births in a tertiary hospital in Da Nang, Vietnam: a pre/post-intervention study

BMJ Open Quality ◽

10.1136/bmjoq-2020-001089 ◽

2021 ◽

Vol 10 (3) ◽

pp. e001089

Author(s):

Hoang Thi Tran ◽

John Charles Scott Murray ◽

Howard Lawrence Sobel ◽

Priya Mannava ◽

Le Thi Huynh ◽

...

Keyword(s):

Quality Improvement ◽

Relative Risk ◽

Caesarean Section ◽

Environmental Changes ◽

Newborn Care ◽

Adverse Outcomes ◽

National Guidelines ◽

Post Intervention ◽

Essential Newborn Care ◽

Newborn Outcomes

BackgroundTo improve maternal and neonatal outcomes, Vietnam implemented early essential newborn care (EENC) using clinical coaching and quality improvement self-assessments in hospitals to introduce policy, practice and environmental changes. Da Nang Hospital for Women and Children began EENC with caesarean section births to inform development of national guidelines. This study compared newborn outcomes after caesarean sections pre/post-EENC introduction.MethodsMaternity records of all live in-born hospital caesarean births and separate case records of the subpopulation admitted to the neonatal intensive care unit (NICU) were reviewed pre-EENC (November 2013–October 2014) and post-EENC (November 2014–October 2015) implementation. NICU admissions and adverse outcomes on NICU admission were compared using descriptive statistics.FindingsA total of 16 927 newborns were delivered by caesarean section: 7928 (46.8%) pre-EENC and 8999 post-EENC (53.2%). Total NICU admissions decreased from 16.7% to 11.8% (relative risk 0.71; 95% CI 0.66 to 0.76) after introduction of EENC. Compared with the pre-EENC period, babies with hypothermia on admission to the NICU declined from 5.0% to 3.7% (relative risk 0.73; 95% CI 0.63 to 0.84) and cases of sepsis from 3.2% to 0.8% (relative risk 0.26; 95% CI 0.20 to 0.33) post-EENC implementation. While more than half of all newborns in the NICU were fed something other than breastmilk pre-EENC introduction, 85.8% were exclusively breast fed post-EENC (relative risk 1.86; 95% CI 1.75 to 1.98). Preterm newborns <2000 g receiving kangaroo mother care (KMC) increased from 50% to 67% (relative risk 1.33; 95% CI 1.12 to 1.59).ConclusionThe EENC quality improvement approach with caesarean section births was associated with reduced NICU admissions, admissions with hypothermia and sepsis, and increased rates of exclusive breast feeding and KMC in the NICU.

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Higher rates of early initiation of breastfeeding associated with health facility delivery in Nepal

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.1121 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

D Dharel ◽

A Bhattarai ◽

Y R Paudel ◽

P Acharya ◽

K Acharya

Keyword(s):

Health Facility ◽

Newborn Care ◽

Facility Delivery ◽

Early Initiation ◽

Health Facility Delivery ◽

Essential Newborn Care ◽

Place Of Delivery ◽

Early Initiation Of Breastfeeding ◽

Nationally Representative ◽

Initiation Of Breastfeeding

Abstract Background Initiation of breastfeeding within one hour from birth is one of the five key essential newborn care messages, implemented along with birth preparedness package since 2008. This study aimed to determine the trend of early initiation of breastfeeding (EIBF) and to assess the effect of health facility delivery on EIBF in Nepal. Methods We analyzed the data from the last four nationally representative Nepal Demographic and Health Surveys (NDHS) conducted in 2001,2006,2011 and 2016. Data on the early initiation of breastfeeding was obtained from the mothers of infants born within 24 months prior to the survey. The explanatory variable was the place of delivery, dichotomized as either the health facility, or home delivery. Survey year had a significant interaction with the place of delivery. Multivariable logistic regression was conducted separately on pooled samples before (NDHS 2001 and 2006) and after (NDHS 2011 and 2016) the program implementation. Adjusted odds ratio (AOR) with 95% confidence interval (CI) for EIBF was calculated after adjusting for predetermined covariates. Results The rate of EIBF increased by 26.5% points (from 32.8% in 2001 to 59.3% in 2016) among infants delivered in a health facility, compared to an increase by 17.1% points (from 29.9% to 47.0%) among home born infants. EIBF increased by 32.5% points before, compared to 49.7% points after BPP. Delivery in a health facility was associated with a higher odd of EIBF in later years (AOR2.3, 95% CI 2.0,2.8), but not in earlier years (AOR1.3, 95% CI 0.9,2.0). Delivery by caesarean section, first-born infant, and lack of maternal education were associated with a lower rate of EIBF in both periods. Conclusions Higher EIBF was associated with health facility delivery in Nepal, only after programmatic emphasis on essential newborn care messages. This implies the need for explicit focus on EIBF at birth, particularly when mother is less educated, primiparous or undergoing operative delivery. Key messages The rate of initiation of breastfeeding within an hour from birth is increasing in Nepal, with higher rates in health facility delivery, as shown by the recent four nationally representative surveys. Programmatic focus on essential newborn care messages may have contributed to significant association of higher rates of early initiation of breastfeeding when delivered in health facility.

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Evidence-based interventions to reduce mortality among preterm and low-birthweight neonates in low-income and middle-income countries: a systematic review and meta-analysis

BMJ Global Health ◽

10.1136/bmjgh-2020-003618 ◽

2021 ◽

Vol 6 (2) ◽

pp. e003618

Author(s):

Mirjam Y Kleinhout ◽

Merel M Stevens ◽

Kwabena Aqyapong Osman ◽

Kwame Adu-Bonsaffoh ◽

Floris Groenendaal ◽

...

Keyword(s):

Low Income ◽

Low Birthweight ◽

Meta Analysis ◽

Neonatal Resuscitation ◽

Newborn Care ◽

Evidence Based ◽

Antenatal Corticosteroids ◽

Essential Newborn Care ◽

Middle Income ◽

Middle Income Countries

BackgroundPreterm birth is the leading cause of under-five-mortality worldwide, with the highest burden in low-income and middle-income countries (LMICs). The aim of this study was to synthesise evidence-based interventions for preterm and low birthweight (LBW) neonates in LMICs, their associated neonatal mortality rate (NMR), and barriers and facilitators to their implementation. This study updates all existing evidence on this topic and reviews evidence on interventions that have not been previously considered in current WHO recommendations.MethodsSix electronic databases were searched until 3 March 2020 for randomised controlled trials reporting NMR of preterm and/or LBW newborns following any intervention in LMICs. Risk ratios for mortality outcomes were pooled where appropriate using a random effects model (PROSPERO registration number: CRD42019139267).Results1236 studies were identified, of which 49 were narratively synthesised and 9 contributed to the meta-analysis. The studies included 39 interventions in 21 countries with 46 993 participants. High-quality evidence suggested significant reduction of NMR following antenatal corticosteroids (Pakistan risk ratio (RR) 0.89; 95% CI 0.80 to 0.99|Guatemala 0.74; 0.68 to 0.81), single cord (0.65; 0.50 to 0.86) and skin cleansing with chlorhexidine (0.72; 0.55 to 0.95), early BCG vaccine (0.64; 0.48 to 0.86; I2 0%), community kangaroo mother care (OR 0.73; 0.55 to 0.97; I2 0%) and home-based newborn care (preterm 0.25; 0.14 to 0.48|LBW 0.42; 0.27 to 0.65). No effects on perinatal (essential newborn care 1.02; 0.91 to 1.14|neonatal resuscitation 0.95; 0.84 to 1.07) or 7-day NMR (essential newborn care 1.03; 0.83 to 1.27|neonatal resuscitation 0.92; 0.77 to 1.09) were observed after training birth attendants.ConclusionThe findings of this study encourage the implementation of additional, evidence-based interventions in the current (WHO) guidelines and to be selective in usage of antenatal corticosteroids, to reduce mortality among preterm and LBW neonates in LMICs. Given the global commitment to end all preventable neonatal deaths by 2030, continuous evaluation and improvement of the current guidelines should be a priority on the agenda.

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The effects of ANC follow up on essential newborn care practices in east Africa: a systematic review and meta-analysis

Scientific Reports ◽

10.1038/s41598-021-91821-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Erkihun Tadesse Amsalu ◽

Bereket Kefale ◽

Amare Muche ◽

Zinabu Fentaw ◽

Reta Dewau ◽

...

Keyword(s):

Antenatal Care ◽

Pregnant Women ◽

East Africa ◽

Meta Analysis ◽

Newborn Care ◽

Cochrane Library ◽

Care Practice ◽

Essential Newborn Care ◽

Newborn Care Practice

AbstractIn the situation of high maternal morbidity and mortality in Sub-Saharan Africa, less than 80% of pregnant women receive antenatal care services. To date, the overall effect of antenatal care (ANC) follow up on essential newborn practice have not been estimated in East Africa. Therefore, this study aims to identify the effect of ANC follow up on essential newborn care practice in East Africa. We reported this review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). We searched articles using PubMed, Cochrane library, African journal online (AJOL), and HINARI electronic databases as well as Google/Google scholar search engines. Heterogeneity and publication bias between studies were assessed using I2 test statistics and Egger’s significance test. Forest plots were used to present the findings. In this review, 27 studies containing 34,440 study participants were included. The pooled estimate of essential newborn care practice was 38% (95% CI 30.10–45.89) in the study area. Women who had one or more antenatal care follow up were about 3.71 times more likely practiced essential newborn care compared to women who had no ANC follow up [OR 3.71, 95% CI 2.35, 5.88]. Similarly, women who had four or more ANC follow up were 2.11 times more likely practiced essential newborn care compared to women who had less than four ANC follow up (OR 2.11, 95% CI 1.33, 3.35). Our study showed that the practice of ENBC was low in East Africa. Accordingly, those women who had more antenatal follow up were more likely practiced Essential newborn care. Thus, to improve the practice of essential newborn care more emphasis should be given on increasing antenatal care follow up of pregnant women in East Africa.

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Essential newborn care practices and associated factors among home delivered mothers in Damot pulasa Woreda, southern Ethiopia

Reproductive Health ◽

10.1186/s12978-018-0609-1 ◽

2018 ◽

Vol 15 (1) ◽

Cited By ~ 6

Author(s):

Tesfaye Yitna Chichiabellu ◽

Baze Mekonnen ◽

Feleke Hailemichael Astawesegn ◽

Birhanu Wondimeneh Demissie ◽

Antehun Alemayehu Anjulo

Keyword(s):

Associated Factors ◽

Newborn Care ◽

Southern Ethiopia ◽

Essential Newborn Care ◽

Care Practices

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Level of Knowledge and Associated Factors of Postnatal Mothers’ towards Essential Newborn Care Practices at Governmental Health Centers in Addis Ababa, Ethiopia

Advances in Public Health ◽

10.1155/2018/8921818 ◽

2018 ◽

Vol 2018 ◽

pp. 1-10 ◽

Cited By ~ 1

Author(s):

Demis Berhan ◽

Hanna Gulema

Keyword(s):

Associated Factors ◽

Maternal Education ◽

Addis Ababa ◽

Newborn Care ◽

Health Centers ◽

Essential Newborn Care ◽

Poor Knowledge ◽

Postnatal Mothers ◽

Level Of Knowledge ◽

Care Practices

Background. Globally 4 million newborns die every year before they reach the age of one month and approximately 3.4 million newborns die within the first week of life. Of these deaths, 66% occur during the 1st 24 hours. Late death, i.e., after 24 hours, still occurs 34% and may be prevented if mothers have knowledge about newborn care including dangers sign of newborn. Objective. The aim of the study was to assess level of knowledge and associated factors of postnatal mothers towards essential newborn care practices at governmental health centers in Addis Ababa. Methodology. Institutional-based cross-sectional study with internal comparison was conducted using multistage sampling method in AA health centers from December 5 to January 30, 2016. Result. A total of 512 mothers who came for postnatal visit were interviewed using structured pretest questionnaires. Knowledge was assessed using closed and open ended questions. Poor knowledge has strong association with women’s occupation (AOR = 2.10, 95% CI : (1.38,3.20)). Parity of the women was found as one of significant predictors for poor knowledge of essential newborn care. Women who were primiparas are 1.99 times more likely to have poor knowledge of ENC compared to women who were multiparas AOR = 1.99,95% CI: (1.25,3.20). The other significant predictors for poor knowledge of ENC were ANC visit. Women who had less than four antenatal visits were 0.63 times less likely to have poor knowledge than those who visit four times and above. AOR = 0.63, 95% CI:( 0.40,0.99). Conclusion. Maternal education programs should be given emphasis for the components of ENC for mothers’ knowledge gaps. Special emphasis needs to be placed when educating vulnerable groups including those who failed to fully attend antenatal clinic visits.

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